Doctor-patient Dialogue Vital

Women are better at asking questions of their doctors and providing the information needed for doctors to make accurate diagnoses, reports the American Society of Internal Medicine.

About 70 percent of an accurate diagnosis depends on communication between the doctor and patient, the society reports. But patients too often view their doctors as authority figures who are too busy or too knowledgeable to be questioned. Doctors can come across as too rushed or abrupt with patients and may tend to control the questioning too much. And, according to a study by the Journal of the American Medical Association, physicians underestimated their patients` desire for information in 65 percent of the cases studied and overestimated the amount of time they actually gave to the patient.

The Society of Internal Medicine advises patients to work hard at getting whatever information they need to make informed decisions and comply with the treatment plan -- even if the doctor appears too busy to offer such information. It may help to write down questions you want to ask your physician before the appointment, then write down what the physician tells you.

Mastectomy patients need not put off having breast reconstruction surgery, say health experts. And today, there are many different alternatives in reconstruction including a novel combination tummy tuck-breast reconstruction.

The sooner women have reconstruction surgery, the better, says a group of psychiatrists who studied 63 patients at the National Institutes of Health. The study compared the psychological problems of women who had breast reconstruction soon after the mastectomy to those who waited more than a year. The women who waited the longest had a higher level of problems.

``The major concern today is not so much whether to reconstruct a particular patient`s breast, but when in the sequence of her treatments or rehabilitation is the optimum time to perform breast reconstruction,`` NIH researchers concluded. More than 110,000 American women undergo mastectomies each year.

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For many patients, the ability to choose from among different types of breast reconstruction is helpful. One of the more interesting new innovations is the tummy tuck-breast reconstruction surgery that was introduced in Florida with the help of Boca Raton plastic surgeon Daniel Man. Unlike most breast reconstructions, this procedure doesn`t require the use of silicon implants.

In the surgery, physicians take a section of the large abdominal muscles and move it, along with skin and fat, into the breast cavity, where it is shaped into a breast and sutured into place. The abdominal skin is then tightened in the same procedure that is used in a tummy tuck operation.

``The patients are very satisfied with it,`` says Man, who has done about 30 of these operations. ``These women didn`t want an implant. They felt more comfortable using their own body. The end result is that (the reconstructed breast) appears and feels just like a regular breast.``

Improvements also are being made on implant reconstructions. Palm Beach plastic surgeon Hilton Becker recently announced the results of his new reconstruction device, a breast-expander and implant that eliminates the need for two surgeries to expand the breast and insert the implant. The procedure can be done on an outpatient basis. The patent is pending for Becker`s device.

ROUTINE CHEST X-RAYS ON THE WANE

In the past, most hospitals gave incoming patients chest X-rays as a routine measure. The idea was that an X-ray could help detect hidden ailments, such as lung cancer, heart disease and tuberculosis.

The Food and Drug Administration, however, recently suggested that routine chest X-rays give so little benefit they should be abandoned. The FDA`s special panel concluded that so few diseases actually are detected that the X- ray was not worth the effort and cost. The panel says routine chest X-rays some companies require of new employees also are unnecessary.

But, the panel suggested, patients entering a long-term care facility and workers in high-risk occupations should have routine X-rays.

CANCER AND CHROMOSOMES

``Fragile`` chromosomes may cause cancer

Genetics seem to have something to do with why certain people get cancer. But now, a University of Minnesota geneticist has an additional theory.

There are 51 fragile sites on human chromosomes that are liable to break and become rearranged, says Jorge Yunis in Science magazine. Some people may be more likely to get cancer because their fragile sites are abnormally weak, says Yunis.